Journal of cataract and refractive surgery最新文献

Purpose: To describe refractive outcomes with intrascleral haptic fixation (ISHF) of the light adjustable lens (LAL).

Setting: Baylor College of Medicine and one private practice in United States.

Design: Retrospective sequential cohort.

Methods: All patients undergoing double-needle ISHF of the LAL were included in the study. Pre-treatment and post-lock-in uncorrected distance visual acuity (UDVA) were recorded. Mean numerical errors, refractive prediction errors, and astigmatism outcomes were measured.

Results: Ten eyes were included. Initial pre-treatment UDVA after surgery ranged from 20/25 to 20/150, and post-lock in UDVA ranged from 20/12.5-20/40 [median UDVA 20/20; mean 0.01 logMAR (SE 0.04)]. Mean magnitude of refractive astigmatism was 0.70D (range 0.00-1.50 D) pre-treatment and 0.25 D (range 0.0-0.75 D) after final lock-in. Pre-treatment mean numerical error was +1.00 D (SD 0.94 D) and was reduced to -0.022 D (SD 0.28) after treatments and lock-in sessions. All eyes (10/10) achieved their full visual potential in UDVA.

Conclusions: Our study illustrates that, with careful planning and patience, patients with poor or absent capsular support who previously did not have a customizable option can potentially achieve personalized visual outcomes with excellent refractive accuracy with scleral fixation of the light adjustable lens.

Purpose: To evaluate long-term outcomes of epithelium-off corneal cross-linking (CXL) on keratoconus progression and visual function across pediatric, adolescent, and adult cohorts in a diverse U.S. population over a 5-year follow-up period.

Setting: A tertiary care ophthalmology center in the United States.

Design: Retrospective cohort study conducted between January 2017 and October 2025 of patients treated between January 2017 and May 2023. Inclusion criteria required a diagnosis of progressive keratoconus and ≥12 months of follow-up.

Methods: A total of 243 eyes from 193 patients were analyzed, including 80 eyes from pediatric patients (32.9%) under 18 years of age. All eyes underwent standard epithelium-off CXL for progressive keratoconus. Clinical parameters, including corrected distance visual acuity (CDVA), maximum keratometry (Kmax), minimum central corneal thickness (CCTmin), and wavefront aberrations (RMS error), were recorded preoperatively and at 12-month postoperative intervals through 60 months.

Results: CXL was associated with significant and sustained visual and structural improvements. Mean CDVA improved significantly from baseline and remained improved through 60 months (p < 0.05). The greatest mean corneal flattening (Kmax) occurred within the first two years, with stability maintained through 48 months (p < 0.05). Postoperative CCTmin overall declined from preoperative baseline, demonstrating a trend of gradual re-thickening consistent with stromal remodeling after 24 months, while remaining below baseline (p < 0.05). Wavefront aberrations remained stable, and adverse events were minimal.

Conclusions: CXL is associated with long-term safety and sustained improvements in visual and tomographic outcomes across pediatric, adolescent, and adult patients in a diverse U.S. cohort, supporting timely intervention in progressive keratoconus.

Purpose: To evaluate the visual, refractive, and aberrometric outcomes of a toric (T) FIL-SSF intraocular lens (IOL) implanted in aphakic eyes lacking capsular support.

Setting: Ospedale Piero Palagi and Azienda Ospedaliera Universitaria Careggi, Florence, Italy.

Design: Multicenter prospective observational case series.

Methods: Aphakic eyes with regular corneal astigmatism >1 D underwent sutureless transscleral fixation of a T FIL-SSF IOL. Preoperative assessment included UDVA, CDVA, manifest refraction, corneal tomography, and biometry. Postoperative visits occurred at 1 day, 7 days, and 1, 3, and 6 months. At 6 months, vector astigmatism analysis, wavefront aberrometry, and IOL alignment were performed.

Results: Fifteen eyes from 12 patients completed the 6-month follow-up. Mean UDVA improved from 0.96 ± 0.25 to 0.19 ± 0.10 logMAR and CDVA from 0.41 ± 0.32 to 0.04 ± 0.05 logMAR (both P < .001). Mean postoperative spherical equivalent prediction error was -0.12 ± 0.54 D. Mean absolute corneal astigmatism decreased from 2.15 ± 0.54 D to a mean refractive astigmatism of 0.73 ± 0.48 D. Wavefront aberrometry showed total astigmatism of 0.36 ± 0.28 µm, with mean total higher order aberrations (HOAs) of 0.24 ± 0.08 µm. Mean IOL misalignment was 3.33 ± 3.42°, significantly correlated with residual refractive astigmatism (ρ = 0.71 P < .01).

Conclusions: T FIL-SSF IOL implantation provided substantial improvements in visual acuity, predictable refractive outcomes, and significant cylinder reduction in aphakic eyes with corneal astigmatism lacking capsular support.

Purpose: To compare lenticular scanning quality and visual outcomes between keratorefractive lenticule extraction (KLEx) performed with VisuMax 800 and VisuMax 500 systems.

Setting: Prospective study at a single ophthalmic surgical center.

Design: Comparative, nonrandomized prospective study.

Methods: Consecutive patients aged 18-46 years were recruited between November 2024 and March 2025. Opaque bubble layer (OBL) and lenticular surface regularity were measured using intraoperative imaging and scanning electron microscopy. Visual acuity and refractive error were assessed at 1, 3 and 6 months postoperatively.

Results: A total of 140 participants (140 eyes) were included (70 per group). The VisuMax 800 group had significantly lower OBL proportions (3.97±2.58% vs. 2.44±0.52%, P=0.013) and better lenticular surface regularity scores (11.85±2.56 vs. 14.98±4.05, P=0.048). In the VisuMax 800 group, higher Flat K and Steep K correlated with larger OBL areas (β=0.412, P<0.001; β=0.358, P=0.002) and larger optical zones were associated with better lenticular surface regularity (β=0.535, P=0.038). No statistically significant difference was observed in the visual and refractive outcomes between the two groups at the 6-month postoperative follow-up (P>0.05). In the VisuMax 800 group, smaller OBL proportions were associated with better visual acuity at 1 and 3 months postoperatively (β<0, P<0.05), while better lenticular surface regularity was correlated with lower astigmatism at 3 months postoperatively (β=-0.574, P=0.002).

Conclusion: While technical advancements of the VisuMax 800 may optimize intraoperative lenticular scanning quality, the VisuMax 800 and 500 systems yield comparable visual outcomes.

Purpose: To evaluate the refractive prediction accuracy of intraocular lens (IOL) power calculation formulas after flanged intrascleral IOL fixation(SF-IOL; Yamane technique) in long axial length (AL) eyes.

Setting: The University of Osaka Hospital, Osaka, Japan.

Design: Retrospective observational cohort study.

Methods: Eyes undergoing SF-IOL between January 2023 and April 2024 were classified into normal (N, <26.0 mm) and long (L, ≥26.0 mm) AL groups. Barrett Universal II, Hoffer Q, Holladay 1, and SRK/T were evaluated. Prediction error (PE) was defined as 3-month postoperative spherical equivalent minus predicted value. Prediction accuracy was assessed using root mean square absolute error (RMSAE) and the Formula Performance Index (FPI).

Results: Fifty-three eyes from 50 patients were analyzed (N=35; L=18). Mean AL was 24.6±0.8 mm (N) and 27.1±1.0 mm (L). Mean PE (N and L) was -0.55±0.72 D and -0.64±0.62 D with Barrett Universal II (P=0.52), -0.68±0.77 D and -0.45±0.62 D with Hoffer Q (P=0.32), -0.78±0.74 D and -0.31±0.72 D with Holladay 1 (P=0.043), and -0.74±0.72 D and -0.62±0.72 D with SRK/T (P=0.60). In L group, Holladay 1 showed PE nearest zero; however, demonstrated steep AL-PE regression slope and low FPI. Barrett Universal II yielded the lowest RMSAE and the highest FPI.

Conclusion: Barrett Universal II demonstrated the highest overall predictive accuracy in long AL eyes undergoing SF-IOL. Although Holladay 1 produced a smaller PE in long AL, this reflected systematic offset rather than superior accuracy, as indicated by its lower FPI.

Purpose: To evaluate inter-expert agreement on epithelial thickness map interpretation and its influence on eligibility decisions for keratorefractive surgery candidates.

Setting: Multicenter international collaboration involving four experienced refractive surgeons.

Design: Retrospective, masked case review study.

Methods: A total of 103 cases were retrospectively evaluated, including patients with normal (n=44), borderline (n=44), and keratoconic (n=15) corneal tomography, as defined by the Belin-Ambrosio-Display (BAD). Four independent experts (MD, JA, AS, NL) first assessed surgical eligibility based on Scheimpflug tomography and subsequently re-evaluated the same cases with the addition of anterior segment OCT-based epithelial thickness maps. To ensure comparability, a standardized questionnaire with nine predefined epithelial thickness characteristics was used. Inter-rater agreement was quantified with Fleiss' kappa (κ), and the relative impact of each imaging modality on decision-making was ranked.

Results: Incorporating epithelial mapping changed the eligibility decision in 19% (77 / 412) of cases. Specifically, 9% (16 / 176) of normal, 20% (35 / 176) of borderline, and 3% (2 / 60) of keratoconic cases were reclassified as eligible, while 2% (3 / 176), 6% (10 / 176), and 3% (2 / 60), respectively, were deemed ineligible. Inter-rater agreement on eligibility was moderate before (κ=0.46) and after (κ=0.43) adding epithelial maps but remained poor in borderline cases (κ=0.14 and 0.12, respectively). Agreement on epithelial profile features ranged from poor to fair (κ=-0.78 to 0.35). Corneal topography and BAD were ranked as most influential, followed by epithelial mapping.

Conclusion: Epithelial mapping frequently shifted decisions toward eligibility. However, poor inter-expert agreement highlights the need for standardized, safety-oriented interpretation to ensure consistent ectasia risk assessment prior to refractive surgery.

Purpose: To compare ultrasound time, energy, and micro-followability with torsional and 4D Phaco in porcine cadaver (simulating grade 1-3 cataracts) and artificial lenses (simulating grade 4+ cataracts).

Setting: Alcon Research, Ltd., Lake Forest, California, USA.

Design: Experimental study.

Methods: A test tube study compared torsional and 4D Phaco for a specified Kitaro artificial lens weight using UNITY® Vitreoretinal Cataract System (UNITY VCS) (Study 1). Time and energy needed to emulsify lens samples were recorded. Wetlab studies using artificial (Study 2) and porcine lenses (Study 3) compared the modalities under simulated surgical settings. A bead video was used to visualize micro-followability in both modalities. Across all studies, balanced tip was utilized, and fluidic parameters were consistent. Total energy into the eye (Joules), energy dissipated at the incision (cumulative dissipated energy, CDE) and ultrasound time were recorded from the machine and analyzed.

Results: Study 1 showed 48% improvement in efficiency (2.86±0.79 vs 5.48±1.27 s/mg), 48% improvement in CDE (0.69±0.19 vs 1.32±0.30 CDE/mg), and 41% reduction in total energy (3.99±1.21 vs 6.78±1.71 J/mg) with 4D Phaco versus torsional. Artificial (32 torsional, 32 4D Phaco; Study 2) and porcine lenses (33 torsional, 33 4D Phaco; Study 3) demonstrated significantly less energy (CDE and J) and ultrasound time with 4D Phaco compared to torsional (p<0.05). The bead study demonstrated enhanced micro-followability with 4D Phaco.

Conclusions: UNITY VCS's 4D Phaco improves efficiency, energy dissipated at the incision site, total energy into the eye and micro-followability compared to torsional phaco, which may translate to better postoperative outcomes.

Purpose: To report refractive changes between 3 and 12 months after Keratorefractive Lenticule Extraction (KLEx) using the VisuMax 800 femtosecond laser in a retrospective monocenter study.

Setting: University Hospital Gießen and Marburg, Department of Ophthalmology, Philipps University of Marburg, Germany.

Design: The 3-month data were collected as part of a prospective, non-randomized, multicenter, international post-market clinical follow-up study for the VisuMax 800 (Carl Zeiss Meditec). The 12-month follow-up was conducted retrospectively at a single center.

Methods: Ninety eyes of 45 patients with myopia up to -10.00 D and astigmatism up to -3.00 D underwent KLEx. Postoperative exams were performed at 3 and 12 months.

Results: At 12 months, 36 patients (80%) completed follow-up. Mean preoperative spherical equivalent (SEQ) was -4.08 ± 2.04 D. Preoperative corrected distance visual acuity (CDVA) was ≥20/20 in 97% of eyes. At 3 months, uncorrected distance visual acuity (UDVA) was ≥20/20 in 89% and ≥20/25 in 99%. SEQ accuracy was within ±0.50 D in 94% and ±1.00 D in 100% of eyes (mean SEQ: 0.11 D). At 12 months, UDVA remained ≥20/20 in 89%, and SEQ accuracy within ±0.50 D in 96% (mean SEQ: 0.06 D). No significant CDVA loss was observed. Minor variations in astigmatism, satisfaction, and OSDI scores between 3 and 12 months were not statistically significant (p > 0.05), confirming overall refractive and subjective stability.

Conclusions: KLEx with the VisuMax 800 yields excellent and stable visual and refractive outcomes with high patient satisfaction and spectacle independence for myopia and myopic astigmatism.

Purpose: To evaluate the longitudinal changes in corneal epithelial thickness following femtosecond laser-assisted in situ keratomileusis (FS-LASIK), keratorefractive lenticule extraction (KLEx), and transepithelial photorefractive keratectomy (tPRK).

Setting: Multicenter, international.

Design: Systematic review and meta-analysis.

Methods: This study is registered with INPLASY (INPLASY202510085). A systematic search of electronic databases was conducted through January 2025 in accordance with PRISMA guidelines. Studies reporting both baseline and postoperative corneal epithelial thickness in myopic eyes treated with FS-LASIK, KLEx, or tPRK were included. Data from 33 studies (n=2,579 eyes) were extracted, with 23 studies incorporated into the meta-analysis. Meta-regressions were performed to identify predictors of epithelial thickness changes.

Results: FS-LASIK-treated eyes exhibited a central epithelial thickness increase of 3.31±0.75 µm at 1 month, further increasing to 4.58±0.72 µm at 6 months. KLEx resulted in central thickening of 2.51±0.28 µm at 1 month and 3.82±0.35 µm at 6 months. In contrast, tPRK eyes initially demonstrated epithelial thinning, followed by central thickening reaching 3.89±0.38 µm at 6 months. Meta-regression analyses indicated that each additional diopter of myopic correction was associated with 1.05 µm greater central thickening in FS-LASIK and 1.04 µm in KLEx at 3 months postoperatively. Additionally, an increase in the programmed OZ corresponded to a reduction in postoperative epithelial thickness.

Conclusion: Distinct epithelial remodeling patterns were observed: rapid, early thickening and stabilization with FS-LASIK and KLEx versus delayed regeneration with tPRK. Baseline SE and programmed OZ are predictors of corneal epithelial thickness changes, suggesting procedure-specific remodeling profiles that may support future refinement of refractive planning.

Purpose: To evaluate the efficacy of hypnosis in anxiety, fear control and surgical ease in refractive surgery.

Setting: One single outpatient ophthalmological clinic in Belgium.

Design: A monocentric randomized prospective study conducted from September 2024 to March 2025.

Materials: Thirty-four patients aged 18-60 were randomized into two groups: standard care (PRK or LASIK) (control) and standard care plus hypnosis (experimental) where patients underwent real-time hypnosis during surgery. Anxiety levels were measured pre- and postoperatively using the Amsterdam Preoperative Anxiety and Information Scale (APAIS), along with heart rate monitoring and surgeon-rated intraoperative parameters. Patient satisfaction and communication quality were also assessed.

Results: Anxiety scores were similar across groups, with no significant hemodynamic differences. However, the hypnosis group showed significantly better cooperation (p = 0.004) and surgical comfort (p < 0.0001). They also reported higher intraoperative comfort, satisfaction and communication quality (p < 0.05).

Conclusion: To our knowledge this is the first study to demonstrate that conversational hypnosis significantly enhances patient experience and surgical cooperation during refractive laser surgery, despite no effect on physiological markers. It represents a promising adjunct relaxing technique useful in outpatient settings.